Office of the Bursar

College Illinois! Certification Form

THIS FORM MUST BE COMPLETED EVERY SEMESTER.

READ AND PROCESS EACH SECTION CAREFULLY - AN INCOMPLETE OR INCORRECT SUBMISSION WILL RESULT IN DELAYS. All documents submitted to the Office of Financial Aid Services must be signed; all e-communications from Financial Aid Services will be sent to student's official Lewis email account.

You must notify our Office of:

Changes in student's schedule

Withdrawal, drops or if additional classes have been added

*Required

Student Beneficiary Information:

*First Name:

*Last Name:

*Student ID:

*Last Four Digits of Social Security Number (XXX - XX - _ _ _ _ ):

*Have you received benefits before?
Yes
No

*Does the student have remaining eligibility?
Yes
No

*For which semester are you completing this form? (Please only choose one)

*Is student registered for classes for above semester?
Yes
No

*Please indicate students registered hours:

*DO YOU HAVE ANY SPECIAL REQUESTS ON HOW LEWIS UNIVERSITY BILLS COLLEGE ILLINOIS! FOR THE ABOVE NAMED STUDENT? E.g.
requesting only a specific amount be billed for semester:
Yes
No

If yes, please indicate here:

Authorization:

* I authorize Lewis University's Office of Financial Aid Services, to bill College Illinois! for tuition and mandatory fees on behalf of the student listed above. Mandatory fees include only those fees required of every student. College Illinois! does not pay for room and board, books, course-specific fees, laboratory fees, etc.